Individual
LEANN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16077 N GLACIER PEAK DR, NAMPA, ID 83651-8723
(208) 466-0868
Mailing address
16077 N GLACIER PEAK DR, NAMPA, ID 83651-8723
(208) 466-0868
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
8078924
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807892400
—
ID
Enumeration date
03/13/2008
Last updated
03/13/2008
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